5 minutes

EHRs and Snow Monkeys: Meaningful Use and the Slow Adoption of EHR Technology

This guest post is provided by Stephanie Sargent, VP of Product Development at Charleston, SC-based SE Healthcare.

Researchers in Japan were studying the macaque (aka the snow monkey) when they observed one female taking sweet potatoes that were left on the beach for them to eat and washing them in ocean water rather than brushing them off as the others were doing. She soon began to dip her potatoes into salty sea water presumably to improve the taste. Others began to copy her, and the behavior was then passed on from generation to generation, until eventually all of the troop, except the oldest members, were doing the same. But let’s press pause on this…for now.

In 2010, Centers for Medicare & Medicaid Services (CMS) published rules related to meaningful use (MU), created to incentivize healthcare providers’ adoption of electronic health records (EHRs).  The concept behind MU is to “meaningfully use” EHRs to engage patients and families in their health, improve care coordination, improve population and public health, and ensure adequate privacy and security protection for personal health information. At the end of 2016, only 63% of all providers had reached Stage 3 of MU requirements.

It seems no industry struggles more with information technology (IT) than healthcare. As technology-heavy as healthcare has become, with cutting edge medical devices, diagnostic technology, and therapies, healthcare’s adoption of EHRs has been a painfully difficult process. The journey from pen to mouse has been fraught with anxiety, resistance, and worse, danger.  

EHRs require a monumental capital expenditure: implementation takes months of project planning, there are many man-hours of staff training, and years of technical assistance is necessary to support users and maintain the systems. In my years of working in hospitals, I’ve seen the complete transition from 100% paper-based documentation and zero on-staff IT personnel to ~75% electronic-based documentation (even the heaviest adopters of EHRs still have pockets of paper-based documentation within their organization) and 100+ IT or EHR-related full-time employees. The financial impact is staggering.  

There is widespread consumer discontent with even the largest EHR vendors in the US. A primary source of concern is lack of interoperability (or systems “talking” to each other) across other IT systems within the organization. Healthcare organizations often make the costly switch from one EHR to another, only to discover that the new one has as many, if not more, flaws and limitations. The cost to switch is so burdensome that the organization finds themselves in the regrettable position of being stuck with the EHR.

Many providers claim that EHRs actually worsen quality of care. Providers claim that computer documentation takes them away from valuable face time with patients (in some settings, providers need to turn their back to the patient to read the medical record, make a notation, or enter an order). Others describe a non-intuitive interface or cumbersome navigation which can lead to medical errors due to overlooking critical information because it can’t be found or is located in some hidden corner of the record. In some EHRs, physicians don’t have access to nursing notes, or nurses can’t view notes from other nurses, for example from the OR to PACU to the acute care area.

During the rollout of a new EHR in the ambulatory setting of a large academic medical center, there was such concern for patient safety that one physician quite vocally and literally threatened to close the clinic for patient appointments for the first 3 days of implementation. Having worked in risk management and patient safety, I can personally attest to tens of serious safety events and medical errors that were either directly or indirectly related to an EHR issue.

Credit: National Geographic

Okay, back to the snow monkey.

Surprisingly, we’ve just barely reached a critical mass for EHR adoption, or “washing our EHR sweet potatoes” (fortunately for the snow monkeys, they did not have CMS pressuring them to wash their sweet potatoes). In one white paper, the authors suggest three practical tactics to improve the relationship between providers and EHRs:

  • Incentivize EHR vendors to improve interoperability through public policy. Improved interoperability would not only facilitate meeting all of MU’s original intents (safety, quality, efficiency, etc.) but also user satisfaction.  
  • Improve providers’ trust in EHRs through careful collection and examination of the user-experience. The frontline worker, those who work in the system, are in the best position to provide insight about problems and resolutions. Decisions to improve the user experience should be based on resources required, rather than resources available.
  • Study the work-arounds. Any work-around is a symptom of a flawed process. Performance improvement efforts should be focused on the “why” and practical solutions.

EHR adoption has been a slow and arduous process.  Despite the barriers, I am certain that government incentives and individual organizational processes could hasten progress. Healthcare will eventually not only be washing their EHR potatoes, but come to find them tastier in the end.  


Author Bio: Stephanie Sargent – VP of Product Development – SE Healthcare

As the Vice-President of Product Development & Quality, Stephanie oversees the continued development of the Physician Empowerment Suite©, and ensures the ongoing growth and success of the Suite and other related SE Healthcare programs. Stephanie is a seasoned clinical and Lean Six Sigma professional with more than 22 years of experience in health care. As a certified Lean Six Sigma Black Belt, she is skilled in identifying clinical and operational performance gaps to decrease professional liability risk, meet regulatory and accreditation requirements, improve clinical quality and patient outcomes and reduce waste and inefficiencies.